The article “Benefits coffers short by trillions” (Business, Tuesday) underscores the urgent need to do something about Medicare. But the problem is about more than money. It’s also about the program’s continued ability to deliver quality, affordable health care to older Americans.

Medicare was created to connect patients with physicians. Today, this lifeline is slowly being severed by what I call “death by a thousand scalpels.”

Cut two: People like Rep. Rahm Emanuel, the Illinois Democrat, who want to add people to Medicare by lowering the age limit.

Cut three: Pushing e-prescribing or other health information technology which forces doctors’ offices to lose even more money if they don’t switch to expensive and unproven electronic technology.

Each cut may be small, but together they are seriously starting to fray the Medicare lifeline. Already, doctors across the country are opting out of Medicare just as millions of baby boomers are about to enroll.

Congress has to find a way to fix these holes and keep the doctor-patient connection before it’s too late.

As a doctor for nearly three decades, I understand what works when it comes to running a medical office, managing patient records and using technology to deliver better care.

I also know that market-oriented policies, not top-down mandates from Washington, are the real prescription for better health care. Congress should consider these things as we work to keep the Medicare program healthy.

REP. MICHAEL C. BURGESS

Washington

HIV/AIDS and personal responsibility

I must assume that Dr. Gary Blick is a pseudonym and that his Monday letter, “A weak response to HIV/AIDS,” is satire.

His point that the only problem in persuading potential HIV/AIDS sufferers to get tested is that it costs the person being tested $5.36 or $11.46, depending on his or her insurance, or $17.50 for the uninsured.

His protestation of the burden of paying up to $17.50 does not convince anyone that cost is the problem, and therefore this appears to be a joke.

He then shoots down his concern about those not getting tested by complaining that Medicare won’t pay for the cosmetic procedure to hide the infection.

The real truth about the cause of HIV/AIDS infection in America, as well as in Africa and elsewhere, is sexual promiscuity.

If there were no sexual promiscuity among heterosexuals or homosexuals, further HIV/AIDS transmission would end very quickly. It is criminal to spend taxpayers’ hard-earned money for HIV/AIDS funding that concentrates on anything other than ending sexual promiscuity.

WAYNE HEMBREE

Bowie

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In his Monday letter, “A weak response to HIV/AIDS,” Dr. Gary Blick blames the government for the disappointing response to the call by the Centers for Disease Control and Prevention for routine HIV testing.

I have been personally involved in the HIV diagnostic industry since it appeared in the mid-1980s. (HIV had been around since the early 1960s but did not appear as full-blown AIDS until the ‘80s.)

Diagnostic testing has been available for more than 20 years. Many promising events have occurred in both the diagnosis and treatment of HIV/AIDS, but many disappointments likewise have occurred, and most have been blamed on the government.

HIV diagnosis has been available for years for pregnant women and, with prophylactic treatment, can be the lifesaving step for the resultant newborn.

This test was blinded for years to “protect” the expectant mother from the stigma of being labeled HIV-positive; thus, the HIV virus likely was passed to the newborn.

HIV diagnosis in pregnant women is still not required universally because of privacy issues, not government intervention.

Public HIV clinics offer free on-site “quick” testing, to which Dr. Blick referred. This provides results and counseling availability in minutes rather than days. The problem is that when a test is positive or indeterminate, it must be confirmed by a more sensitive lab test, and the individual must return or call in to retrieve the results in a week.

Most testing sites report 40 percent to 70 percent of those needing extra testing results do not return. Reasons given range from individual denial to fear of the result to simply not caring.

Is this a government problem?

The testing is paid for; supported care and therapy is available; and the clinics and counselors are all government-funded.

All also can be tested by a laboratory blood test from routine samples drawn at any doctor’s office or hospital. This type of testing usually is paid for by private insurance or HMO reimbursement, and the cost is just $5 to $8, including labor and confirmation testing of the small percentage needing a supplemental test.

This is not a government issue or a greedy-insurance-industry issue; it is a personal accountability and personal choice issue.

We need to stop blaming the government for the HIV issue and look at advocates blocking routine HIV testing. If it is one’s choice not to be tested and to remain ignorant of HIV status, what choice does the individual have who unknowingly gets the disease from that ignorant person?

I guess he or she can blame the government.

R. CHIP STEPHENS

Westport, Conn.

Stop illegals and their enablers

Thank you for your excellent article on Saturday’s DefendDC demonstration (“Protesters want day laborers out of NE plaza,” Metropolitan, Sunday). Our goal was to get the owners of the Rhode Island Avenue shopping plaza to stop allowing illegal workers to congregate on their property. My only regret is that none of the many Ward 5 residents who demonstrated was quoted.

According to David Thurston, director of the D.C. Alliance for Immigrant Justice, “These workers are looking for dignity and employment. It’s for the benefit of the entire community.” But dignity is not something you gain by breaking the law.

Ward 5 residents are livid over public drinking and urination, harassment of women and property invasions by these illegal workers.

Black Washingtonians, including returning ex-offenders who have unemployment rates exceeding 10 percent, may also have a problem believing illegal job-seekers are a benefit.

Mr. Thurston thinks DefendDC ought to change its name to DivideDC. He’s on to something there. It is definitely our goal to divide the District to separate the legal workers from the illegal workers, something D.C. police are currently forbidden to do.

Illegal employment of undocumented workers is the magnet that generates illegal immigration. The Rhode Island plaza has become the entry point for this crime in the District.

Anyone who comes across our border without inspection is guilty of a misdemeanor and can be fined and imprisoned for up to six months.

A second offense is a felony. There are also criminal penalties for document fraud. Employers who knowingly hire illegal workers are subject to fines and any employer who picks up a worker at the Rhode Island plaza knows he is employing someone the law forbids him to hire.